Risks & Dangers of Quitting Alcohol Cold Turkey

In order to define ‘alcoholism’, 23 members of the National Council on Alcoholism and Drug Dependence Committee, along with members of the American Society of Medicine, carried out a 2-year study.

This trial studied the definition of ‘alcoholism’ with 3 goals in mind: [1]

1. Make the definition scientifically valid;
2. Make the definition clinically useful; and
3. Make the definition understandable to the public

As a result, the committee settled on defining alcoholism as a “primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations”. [2]

Alcoholism is often progressive and can be fatal. It is also characterised by periodic or continuous:

• Impaired or lack of control over consuming alcohol
• Preoccupation with alcohol
• Use of alcohol despite the negative consequences on family, friends, and both physical and mental health
• Denial of alcoholism

Excessive alcohol consumption changes the circuits in the brain, these circuits involve the control of stress, reward, and self-control. The adaptation of these circuits leads to patterns of addiction.

Withdrawals: Symptoms and Timeline

Once the body and brain become addicted to alcohol, cutting down or deciding to be abstinent from alcohol will result in withdrawal symptoms. [3] [4]

Over half of individuals with an alcohol use disorder will experience alcohol withdrawals when they suddenly stop drinking, this is called quitting ‘cold turkey’. [5]

The common symptoms of withdrawals include the following:

• Sweating and flushing
• Rapid heart rate and heart palpitations
• High blood pressure
• Headaches
• Insomnia and trouble sleeping
• Nausea and vomiting
• Hallucinations and delusions
• Anxiety and depression
• Agitation and mood swings
• Tremors
• Shaking
• Delirium tremens

Stopping drinking suddenly with the aim of recovery is called going ‘cold turkey’.

What happens when you go ‘cold turkey’ depends on the following factors:

• How much you drink
• How often you drink
• How long alcohol was consumed for before withdrawal
• History of alcohol withdrawal
• Comorbid physical and mental health conditions

These withdrawal symptoms differ according to the person, but they will usually begin around 12-24 hours after the last drink. The most severe symptoms will pass in the first 5 days, but the moderate symptoms can last for weeks.

The first 6 to 12 hours after the last drinks, the mild withdrawals will set in. These milder symptoms of withdrawal often present as insomnia, anxiety, tremors, headache and stomachache, excessive sweating, heart palpitations, and a lack of appetite.

At the end of the first day of going ‘cold turkey’, hallucinations tend to occur.

On the second day of withdrawals (24-48 hours after the last drink), if seizures are imminent, they will set in. After 2 days of alcohol withdrawals, health risks are at their highest. There is a risk of delirium tremens (DT) on the third day (48-72 hours).

Delirium Tremens

Delirium tremens, also referred to as ‘alcohol withdrawal delirium’, was first recognised in 1813 as a known disorder directly caused by drinking alcohol in excess. [6]

After abrupt cessation of alcohol, delirium tremens can last up to 5 days. Delirium tremens causes death in around 37% of patients that do not seek or receive adequate treatment. This is why it is crucial to identify the early warning signs of DT.

The highest risk factors for DT are: [7] [8]

• A history of delirium tremens
• Past seizures
• Presence of concurrent illnesses
• Comorbidity
• Long time period between now and the last drink
• Advanced age
• Hypokalaemia

The common symptoms of DT are:

• Visual hallucinations and delirium
• Profound confusion
• Tachycardia (increased heart rate)
• Hypertension (high blood pressure)
• Hyperthermia
• Agitation
• Diaphoresis (excessive sweating)
• Change in mental function
• Sound, light, and touch sensitivity

To evaluate patients, the professionals evaluate the severity of the alcohol withdrawals, based on the patient’s history and the symptoms presented at the clinic.

The modern assessment for alcohol withdrawal symptoms is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar).

This is a questionnaire consisting of 10 questions that help evaluate, monitor, manage, and treat the symptoms of alcohol withdrawal. [9] [10]

• 0 to 8 points on the assessment indicate mild withdrawal
• 9 to 15 points on the assessment indicate moderate withdrawal
• 15 points or more indicates severe withdrawal symptoms, with a high risk of seizures and delirium tremens.

Once the patient has scored over 15 points and is at risk of DT, medical professionals will carry out additional evaluations. Medical professionals will assess any electrolyte nutrition and fluid abnormalities.

Patients that are suffering from DTs will present with severe dehydration, defined as being deficient in up to 10 litres of fluid.

Patients may also be asked to complete the following tests:

• Blood phosphate level
• Blood magnesium level
• Comprehensive metabolic panel
• Electrocardiogram (ECG)
• Electroencephalogram (EEG)
• Toxicology screen

Quitting alcohol ‘cold turkey’ does not come without serious medical risk. Dehydration, electrolyte imbalance, and malnutrition can lead to complications. [11]

• Electrolyte imbalances causes an irregular heartbeat
• Malnutrition can lead to a thiamine deficiency, resulting in Wernicke Korsakoff Syndrome

Wernicke Korsakoff Syndrome

Wernicke Korsakoff Syndrome (WKS) is formed of two separate syndromes, developing from one to the next, resulting in WKS:[12] [13]

1. Wernicke’s encephalopathy: characterised by confusion, muscle coordination issues, and optic nerve paralysis
2. Korsakoff psychosis: characterised by long-term memory issues and learning disabilities.

WKS is a condition that mirrors the symptoms of dementia, directly caused by alcohol abuse. Alcohol stops the brain from absorbing enough thiamine (vitamin B1), which prevents the brain cells from functioning effectively.

The first stage, Wernicke’s encephalopathy, causes the brain to swell. If this inflammation is left untreated, it will develop into the second stage of WKS, Korsakoff psychosis.

The memory loss experienced will usually concern the events after the individual developed Korsakoff psychosis as they cannot form any new memories.

Past memories and events can also become distorted, whilst new information and skills are difficult to process. They may have difficulty processing any decisions, planning, concentrating, and solving any problems.

This may result in a change of personality, involving the lack of ability to process emotions or emotional reactions, and they may become very talkative.

The individual may also start to fill their memory with false events to fill the gaps. This is called confabulation; this usually starts in the early stages of WKS, but the individual still believes these stories to be a real memory.

Quitting ‘Cold Turkey’ vs Medical Tapering

Due to the symptoms and conditions that follow alcohol withdrawals, patients will benefit from a medical detox and professional supervision.

This often includes medication to reduce risks from severe symptoms – this will be provided if the patient seeks a medical detoxification programme, the first stage of an addiction treatment plan.

This may be an inpatient treatment facility or an outpatient treatment programme. For severe addiction, patients are asked to check into an inpatient facility to be monitored under close supervision by medical professionals.

Healthcare professionals and specialists will provide safe treatment and a comfortable environment 24/7, managing withdrawal symptoms that pose a threat to life. [14]

Medication will be offered, usually in the form of a benzodiazepine such as Librium, to manage symptoms and reduce the risk of severe complications such as seizures and delirium tremens.

This is called medical tapering; this regimen gradually decreases the medication provided during detox at specific individuals. This is strict and will not be affected by the severity of symptoms.

‘Cold turkey’ is a quick fix rather than a gradual tapering. The term ‘cold turkey’ comes from the appearance of goosebumps people experience during withdrawals, looking like the skin of a cold turkey.

The reason many people choose to go cold turkey is due to cravings. They believe that if you stop using a substance and don’t have it around you at all, you won’t be tempted.

After finding out some of the most damaging effects of alcohol, some people want to quit straight away to stop bodily harm or prevent further damage.

However, this may work for some people, but it is not effective nor is it the safest way of quitting alcohol. Quitting cold turkey doesn’t rewire your brain the way tapering off alcohol does, so it is more likely that the patient will relapse if they decide to quit alcohol cold turkey.

Quitting alcohol immediately and starving your body and brain of something you have been addicted to will lead to uncomfortable and dangerous withdrawals. Whether quitting cold turkey will lead to sobriety depends on the substance and the severity of the addiction.

If the alcoholism in question is mild, going cold turkey during a home detox may work and remain safe. However, for severe alcoholism, it is much safer to seek medical help and taper off rather than quitting cold turkey.

Your tolerance to the substance is lowered after you quit as your body and brain readjust. If you consume the same alcohol as you drank mid-addiction, you are more than likely to overdose, and it may be fatal.

Heavy drinkers are at risk of fatal withdrawal symptoms if they quit cold turkey. These dangerous symptoms require a medical detox to reduce the effects of alcohol withdrawal. Once you seek medical attention or medical assistance, you will likely receive prescription medication for your alcohol addiction.

The detox process should be followed by behavioural therapies to tackle severe alcohol dependence. Long-term alcohol abuse and past heavy drinking require the most attention as it is the most dangerous.

Once inpatient treatment has finished, consider a 12-step programme such as Alcoholics Anonymous at outpatient treatment. This will work on the mental effects that addiction has had on you and your loved ones.

References

[1] Morse RM, Flavin DK. The Definition of Alcoholism. JAMA. 1992;268(8):1012–1014. doi:10.1001/jama.1992.03490080086030

[2] Criteria Committee, National Council on Alcoholism. Criteria for the diagnosis of alcoholism. Ann Intern Med . 1972;77:249-258.

[3] Tiglao SM, Meisenheimer ES, Oh RC. (2021). Alcohol Withdrawal Syndrome: Outpatient Management. Am Fam Physician, 104(3), 253-262.

[4] Muncie HL Jr, Yasinian Y, Oge’ L. (2013). Outpatient management of alcohol withdrawal syndrome. Am Fam Physician, 88(9), 589-95.

[5] Gortney, J.S., Raub, J.N., Patel, P., Kokoska, L., Hannawa, M., & Argyris, A. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67-79.

[6] Rahman A, Paul M. Delirium Tremens. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482134/

[7] Sutton LJ, Jutel A. Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management. Crit Care Nurse. 2016 Feb;36(1):28-38.

[8] Gortney JS, Raub JN, Patel P, Kokoska L, Hannawa M, Argyris A. Alcohol withdrawal syndrome in medical patients. Cleve Clin J Med. 2016 Jan;83(1):67-79

[9] Rastegar DA, Applewhite D, Alvanzo AAH, Welsh C, Niessen T, Chen ES. Development and implementation of an alcohol withdrawal protocol using a 5-item scale, the Brief Alcohol Withdrawal Scale (BAWS). Subst Abus. 2017 Oct-Dec;38(4):394-400.

[10] Jesse S, Bråthen G, Ferrara M, Keindl M, Ben-Menachem E, Tanasescu R, Brodtkorb E, Hillbom M, Leone MA, Ludolph AC. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol Scand. 2017 Jan;135(1):4-16.

[11] Gortney, J.S., Raub, J.N., Patel, P., Kokoska, L., Hannawa, M., & Argyris, A. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67-79.

[12] National Institute on Alcohol Abuse and Alcoholism. (2004, October). Alcohol’s damaging effects on the brain.

[13] https://www.ninds.nih.gov/health-information/disorders/wernicke-korsakoff-syndrome#:~:text=Korsakoff%20syndrome%20(also%20called%20Korsakoff’s,the%20brain%20involved%20with%20memory.

[14] National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).

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